Monday, July 26, 2010

monday, July 26, 2010

Back home, exhausted but pleased. The plan ride home was about 22 hours, and I could only sleep intermittently on the place. I slept for about 15 hours when I got home.

Its nice to be home, in fact it is great to be home. But home feels different; from time to time the United States feels like a foreign country, and Rwanda feels like the more natural setting. I expect that this will pass.

This is probably my last blog until the next trip.

Friday, July 23, 2010

Friday, July 23, 2010

This will probably be my last blog post this trip. I'm leaving tomorrow for home; it will be good to be back.

I just finished sending David and Gabo a concept paper based on the interviews. It has to do with the process of dehumanization and rehumanization, which I hope to develop further. I'll send a copy to anyone who is interested. You know where to find me.

I talked to Odette Kayirere today, the director of AVEGA in the Eastern region. We talked about the tradition Rwandan view of the world, including traditional Rwandan psychology although they don't call it that. In many ways it seems to coincide with a lot of family therapy ideas. The ancestors are always present, they want things from the people still here, they affect what we do, they need to be kept satisfied etc. The difference between this and Western views is that they believe it is literally true.

However, Odette is suspicious of some traditional healing methods. She says that people who are schizophrenic are often seen as possessed by the ancestral spirits and treated by traditional healers, who don't help. Only after they have spent all their money do they go to the psychiatric hospital for medication. The relationship between traditional healing and Western psychology/psychiatry seems complex. I've heard other Rwandans who are suspicious of traditional practices. On the other hand, Odette's daughter, who I also met today, is interested in research on traditional Rwandan medicinal plants. She says that they need research to investigate how and when they are effective.

Thursday, July 22, 2010

Thursday, July 22, 2010

Good news. I spoke with Gabo today about my ideas, particularly that the rwandan genocide dehumanized the survivors, and that recovery and healing is a process of rehumanization. He liked the idea, told me that it clarified for him the work that they were doing, and told me that if I needed to collect more data they would raise money for me to return. This is very gratifying, and also makes me nervous. I'm going to write them a brief concept paper which will summarize the ideas and we will take it from there. This is all I could have hoped for; no, it is more than I could have hoped for.

BTW, people here don't call what happened "the Rwandan genocide." They refer to it is "the genocide against the Tutsis." Language makes a difference.

I had lunch with Henny, Sheila's friend Pauline's friend. She is a therapist and a medical anthropologist. She told me about the dark side of traditional Rwandan culture. Traditional Rwanda was a patriarchal culture that subordinated women, and condoned violence against women as a mean's of social control and enforcing gender norms. Now that Kagame's government has greatly improved the status of women (may women in government, in business, etc) traditional men are threatened. They say that the government is taking away their manhood. Pauline is studying gender based violence in Rwanda.

So there is trouble in paradise. Another important corrective to the good things in traditional culture that I talked about in my earlier blogs.

Tuesday, July 20, 2010

Tuesday, July 20, 2010

I did a small focus group with counselors from AVEGA and solace ministries yesterday. I've formulated a very tentative narrative about the process by which they work with people. I'll paste it below right after I comment/complain about what seems to be a typical hassle: people promise things, don't or can't deliver, and then avoid me rather than explain. In this particular case I was told I would get a CD of the recorded interview right away. I only found out from a chance encounter that they needed permission from someone else to bill SURF, the survivors fund. Of course, there are the same hassles at Yeshiva, but they feel more difficult here, probably because I don't know who is who or whom to ask. I also need to figure out a way to turn this into an open ended survey. suggestions welcome.

1.Dehumanization leading to isolation and marginalization - Z is a young man whose arm was hacked off during the genocide. When he came for treatment he was not working felt worthless, not a man, not part of the community of his village. In fact, he couldn’t do farm work and had no training for any other occupation. He felt ashamed of his state, although the shame was not something he could give voice too, speaking about feelings isn’t part of Rwandan culture.

2.The marginalization and isolation create problems which bring person to the attention of or into contact with the CTP system – the people in his village brought him to the attention of solace ministries because he was given to angry outbursts directed at people in his village. They were both frightened of his and concerned for him, and didn’t know what to do.


3.Outreach and establishment of trusting relationship – he wouldn’t travel to the facilities that solace ministries had, which were too far away, and also he didn’t know anybody there. The ministry established a facility closer to him, which he was willing to attend. However, when he met the worker he wouldn’t say anything to her. At some point when she persisted he began hitting her with the stump of his missing arm, uttering the words “human, human, human” which she took to mean that he was a human being, despite what was done to him. As she persisted he began talk about what happened to him. After many sessions of telling his story he broke down into tears and cried for 20 minutes. When he stopped crying he asked the worker what she had done, and said he had tried to be strong and having cried he was weak. (Showing emotions is a taken for weakness in Rwandan village culture.)

4.Stabilization, stopping of decline – he began to be less angry and disruptive of village life, more connected to the village and more social.

5.Rebuilding life, family connection, identity ¬– after much talk and encouragement he began to feel less hopeless about his life, and to see other possibilities. He asked to be sent to a local training facility, where he learned to write with his left hand, and got other training as well. He graduated and went to university (I’m not sure of all the details here, but he did find employment). He also began to talk to other survivors, encouraging them to not despair and find a way to live. (If I had more time in the interview, I would have asked for more details. It was a focus group interview with five counselors talking about their clients.) He was worried that he had somehow contracted HIV/AIDS from what had happened to him. He was able to be tested and found that he didn’t have AIDS.

6.Connecting with community, spirituality, the transcendent ¬– this work was done as part of solace ministries who encouraged him to find hope from faith in Jesus, and from the support and fellowship of the community. Again, with more time and more knowledge I would fill in the details.

This is a very sketchy account of narratives I hope to develop. The message is that treating survivors involves going beyond medication and their physical health to the psychological and spiritual issues as well. This particular man didn’t have HIV/AIDS but many of the clients do. I would call this a biopsychosocial approach. One of the pastors I spoke to calls it a holistic approach of body, mind, and spirit.

Sunday, July 18, 2010

Sunday, July 18, 2010

I'm not settled in the guest house of solace ministries, somewhat on the outside of the center of kigali. Its a very different place with a very different atmosphere. Its located on one side of a rough dirt road with only a few houses and faciltiies next to it. As I walk outside of the guest house - it has a gate which opens to the road - I see people who seem much more rural, or at least much less urban. Many women walking side by side in traditional dress, little children who run after me and say hello, just being friendly and curious, young men strolling along. It feels a bit like rural vermont, except for the foliage and the color of the soil, and of course the road isn't paved.

I had a very interesting conversation with an evangelical group who come here every year to work with and pray with surviving widows and orphans. I will skip the evangelical part of the conversation except to note the the group is called wholeness through christ (they are based in canada and have a website which strikes me as somewhat ironic). They said that the people they have talked to and worked with have lost any sense of what i would call social trust or deep meaning, and hence any sense of connected humanity, any source of positive emotion. (I'm translating loosely from their spiritual language to a more humanistic psychological one.) They feel that through their work in community this sense of a meaningful benevolent world can be restored, and that this is necessary for the more psychological kind of work that individual trauma therapists do to be effective.

I find them convincing, although I would quibble about the details of accepting jesus christ as my personal savior. What do find convincing is a need for spirituality and community as part of the healing process, and in Rwanda the spirituality is probably going to be Christian of some sort. I've also found the need for economic development that reaches them and gives them the resources to rebuild their lives. This includes all the microfinances that people talk about.

So I locate psychological work midway between microfinance and spirituality.

Friday, July 16, 2010

Friday, July 16, 2010

I'm back in kigali, staying at the okapi, although I'm about to move to the solace ministries guest house, which is more convenient for the interviewing.

I continue to be fascinated by all the little details of Rwandan life, particularly the collective culture and its pluses and minuses. The minus is public opinion, what people say and think and how much rwandans act to avoid censure. Sylvia told me that Rwandan couples often will not divorce, because it is too shameful. Instead they put on the appearance of happiness in public, and in private lead separate lives.

She and Eric both say that the force of public opinion is diminishing in the city, which is good sociology.

I asked about the street children. Apparently their parents send them out to beg, to make a little money for the household. I say parents but it is often only one parent, maybe disabled by the genocide or for some other reason. The effect is that they don't go to school, which perpetuates the poverty. Apparently it is illegal to give them money in some places, and people who do so are fined.

Also, there is no social security in Rwanda, except for people who work for the government, so people work till they die.

Thursday, July 15, 2010

Thursday, July 15, 2010

I'm back from Butare, and this is the first time I've had access to the internet. BTW I've just learned it is possible to buy a modem and get internet access that way. I'll do that soon. I'm slowly learning all the little ways of coping that make it possible to get around. Probably there will be more hassles and more learning coping strategies.

The visit was a success. I got a letter of invitation from the National University which I can use in support of my Fulbright. Speaking of coping strategies, this is quite a story. When I arrived in Butare I immediately called Vincent Sezibera, the head of the department of clinical psychology at NUR (the national university). He showed up to greet me at the hotel where I stayed, said he would be right back and vanished. I called him a bit later, and he explained he didn't want to bother me, but said I could meet him at his office at 2:30. Again, he wasn't there, and again I called. It turned out he was in a meeting and arrived at 3:30. We had a good talk about our mutual interests and my teaching, and he said he would be glad to write a letter, and ask for administrative approval. He also introduced me to the Dean of the Medical School who was approving of the application. It was important that the Fulbright committee would pay all expenses, so that the university had nothing to lose by having me. The dean introduced himself as Patrick - I think everything is on a first name basis because of the way Rwandans are given names. If I want an honorific i address him as Dean Patrick.

By this time I had learned what I could count on from Vincent and what I couldn't, So I said I would write the letter myself, and have him edit it. My assistant, Sylvia, who is absolutely amazing, dug up the name and phone of the rector and vice rector and made an appointment for me the next day at 11. I actually met the vice rector at 12 - after his other meetings were delayed. His name is Professor Martin O'Hara, and he is a displaced Englishman, I think, or perhaps Irish. In any event he was enormously courteous and helpful. He told me just write the letter, bring it to his office, and they will print it out on official stationary and sign it.

I called vincent told him this, and he agreed to meet me at his office at 4:30. By now its clear what was going to happen. He wasn't there. I left a note, we drove off, and as it happened as we were pulling into my hotel Sylvia and Eric saw Vincent driving past in a green van. I said let's follow the van and we did. After a short drive Vincent pulled off the road into a small building that turned out the be the University clinic. Other people were waiting for him there, too, apparently wondering why he hadn't kept his appointment with them. He had the grace to look embarassed.

Sylvia says he is on African time. I think she trusts me enough to say this. Eric says so too, but doesn't think African time is a good thing. We joked that if he had an appointment with Kagame at 4:30 he would sleep in his office, for fear of missing it. I'm not sure why it occurs. I don't think "African culture" per se is a good explanation. Sylvia says it is a culture of come back tomorrow. She also says that in Uganda requesting bribes for services isn't done, you just simply tell people come back tomorrow until they pay.

But in any event, I finally did meet with Vincent, we did write the letter together, we took it to O'hara's office, and he signed it and gave me a hard copy and also scanned it into a file for a permanent record. I'm going to keep it in several different places.

We drove back to Butare, and on the road I had a very interesting conversation with Eric and Sylvia about the role of group pressure in Rwandan behavior. To make a long story short, they don't like it. They are aware of the pressure to follow the norm, marry just to be married, etc. Eric says that group pressure is the negative of Rwandan culture.

Sunday, July 11, 2010

Sunday, July 11, 2010

This is the first day I've actually felt physically OK. My cold is gone, except for a slight cough, and I'm not tired all the time. Its hard being sick anywhere, and it's particularly hard while alone in East Africa. I hadn't realized just how much the isolation would bother me. Perhaps I'm getting more mentally healthy and connected, which is certainly a mixed blessing. I wonder if I can get my old cut off self back. This will be a real issue when I take my sabbatical. Or if, but I think I will get the fulbright if I get the letter of invitation.

The woman who was going to be my guide at the National University turned out not to be available. Actually, she was willing to do it but her father wouldn't let her go. More on that later. Fortunately Eric knew somebody who could do it. Eric seems to know people everywhere. No matter where we are we always run into somebody who says hello to him. I joked with him that when I was leaving the doorman in my building said "say hello to eric." This isn't true, but it might have been.

When the woman I was going to hire, Alice, said her father wouldn't let her come, I asked if I might meet her father and her family. Actually, I had mentioned this to her earlier, since I thought her father wouldn't let he go without knowing who she was travelling with. She didn't think it was necessary, but I did, and it turned out to be right. (It is still a traditional society although this is changing, and in this case the father was the one to give permission - or not, as it turned out.) Anyhow I went to their house in a relatively well to do section of Kigali, and met the family. It was what I have come to see as a conventional Rwandan negotiation. About an hour of small talk and hospitality, then a meal, and then discussion. The discussion was in english and french. I can't really say much in french but they appreciate my making the effort.

In any event, the father didn't change his mind. Perhaps he isn't used to changing his mind. But i did meet him, and also alice's mother, who is blind and paralyed from the waste down from bad medical care, they say. I also met alice's fiance and we talked about how they met, how they fell in love, when they would be married, etc. They met in the course of business, Seth, the fiance had business where alice worked. At first they were friends, then they discovered they had a lot in common, and then decided each was the one for each other. What they had in common was that they liked the same literature, had the same outlook on life and africa, and were ambitious. They will be married when she finishes school. His family is in the congo and she will go to meet them. They his family will give her family a cow to cement the union. They are quite clear that a marriage is a union of families (I don't know if the cow is literal or a metaphor, and couldn't quite get clear. I think they found the subject embarassing, not quite modern). Were they physically intimate, you might be wondering? I don't know and didn't ask. I think the norms are changing.

It is still patriarchal, though. Alice served everyone food and drink. She did it with a kind of devoted gesture and expression, particularly when serving her father, that I can't imagine anyone american doing. Almost like a sacred duty.

Communal culture. I spoke to JB about this, and his friend chantal, who told me several interesting things: The child belongs to the village before it belongs to the family, at least traditionally. People will always give to each other to make sure that no-one is lacking. They will even give when they don't have enough. Neighbors take care of each other. Reciprocal altruism, theory calls it, and it is a survival mechanism, I think. Solidarity is enforced unoficially. If a person or a family moves into a compound and isn't sociable, the neighbors will come by and ask him what his problem is, what is the matter with him. The pressure is hard to resist.

Chantal raised a question. If people are so neighborly and so altruistic, how is it that neighbors killed neighbors in the genocide? It makes sense that we are evolutionarily predisposed to reciprocal altruism, which makes collective societies possible. What evolutionary predisposition makes genocide possible?

Friday, July 9, 2010

Thursday, July 9, 2010

First of all, thanks to everybody who is posting comments. It helps me keep a link to home and my old identity, and is very comforting.

My research plans are going very well. Better than I had any right to expect. Sheila told me that readers may not know who everybody is, so I'll start with that. David Russell is the diretor of SURF, the survivors fund that raises money for rwandans affected by the genocide. David is British, very British. Gabon wilson is the director of SURF in Rwanda, and is a native of Rwanda. I don't know his story.

AVEGA is a rwandan organization that works with survivors of the genocide. The other organization i've met with is Solace Ministries, an evangelical organization that does the same work as AVEGA.

The situation i was puzzled about yesterday is clearer now. The survivor organizations are being made part of the public health system, subject to those budgetary constraints, which means that they can't offer all the services they once did. In addition, they lost funding from private sources, so can't supplement their public funding.

The research that I'm planning with David and AVEGA and Solace ministries is aimed at documenting the need for special services for survivors, and thus maybe getting some funding back. It will be a mixed methods study, beginning with a qualitative component and then adding a more structured survey component. The aim will be to show how the recovery process from the genocide works, and what the survivor organizations provided, or used to provide. Strange how a lot of the things I've been saying in my classes, and Louise has been saying in hers, are turning out to be right. There is no way that we could have designed a study without a qualitative culturally sensitive piece,

In talking to solace ministries i've learned something major about the trauma of the genocide. It is not just that people develop symptoms, although they do. More important, they lose their identity and their humanity. As the pastor of solace says: if you are called vermin and cockroaches, and hunted and raped and killed, and then shunned in Rwandan society, you no longer feel human. Treatment must first of all restore humanity and human dignity. One of the functions of the "active listening" of therapy, he says, is to convey to the person that they are worth listening too, and therefore still human. They do this in community, in the case of solace a church community, where people matter to each other. The pastor told me that people who don't have the money for public transport will walk three hours from their village just to get to the meeting.

There is a lot to learn here for the West. We talk about trauma as something that happens to individuals, to be cured individually. I've said this before, but it is becoming clearer.

Another cultural tidbit, changing the topic. Eric, my driver, asked me if I had grandchildren. When I said yes he asked me if they lived with me. He was shocked when I said no. In Rwanda, apparently, one of the grandchildren is sent to live with the grandparents so they will not be lonely. The grandchildren also run errands and do small chores for the grandparents. It is a different world.

Eric was also shocked that I didn't know the neighbors in my building.

There is so much need here. Gervais, one of the waiters at the Okapi, who denise and i really liked, asked me if I would pay for his education. He is an orphan, both of his parents killed in the genocide, and works at the hotel to support himself. I think he goes to school a bit, but can't afford the university. I said that I was sorry but I couldn't, that I didn't have the money. I also said I would ask my friends in America, which really was just to alleviate my guilt. I'm going to talk to David Russell about this, if there are ways in which it would be possible for a local organization to "adopt" him. But even if this were possible it wouldn't be simple - who would monitor him, how would the money get to him, etc, - and anyhow there are thousands of Gervais. In any event, I said desole, and he said pas de probleme, and we went back to customer waiter relations, both smiling at each other. Or did we? I think I'll be living with this for a long time.

Wednesday, July 7, 2010

Wednesday, July 7, 2010

Research developments. David and Gabon have decided that they aren't going to apply for the USAID grant. They've learned that to get it you have to have already gotten it. USAID wants to fund people that they've already worked with, so they think the chances of writing an acceptable application in such a short time is nil, and are dropping the project.

On the positive side, they've asked me to help them design a public health study. All Rwandan organizations that used to be for survivors only are now being required to serve everybody. As part of this the government will cut the amount of funding these organizations get, although as I write this the connection is lost on me, but it is there nevertheless. The study we have in mind is a study to assess the impact of limited services. It will be a mixed method study. A small qualitative study to learn what questions to ask, and then a larger questionnaire or survey. I'll be working with Odette, and will meet with her and her program manager to work out the details. Who would have thought. This could develop into a larger collaboration between Rwanda and YU, so I'm hopeful.

I drove around Kigali today with Eric, trying to learn the organization of the city. He is also my informant about Rwanda culture. I asked him if Rwandans are ever alone, and he gave the one word answer - no. I asked if they ever wanted to be along, and he gave almost the same answer - maybe in the city sometimes, but not in the country. Then I asked if he ever wanted to be alone. He said only after he is back from a long trip and he needs to shower and sleep. Otherwise he enjoys the continued contact with people. He lives in a small compound of 10 people and they all check up on each other. If they don't see him for a day they check to find out if anything is wrong. He told me that every morning neighbors go by his house, and if it is too early to knock they say to the door: hello eric's house, how is eric. He does the same for them.

A lesson in communal culture.

Monday, July 5, 2010

Monday, July 5, 2010

Well, things are beginning.

I met with eric this morning and he is definitely my driver. It was nice to see him, and nice to just have the arrangements done. I said we'd have the same arrangments financially as before and he agreed without blinking. I was worried about an intense negotation, but no need.

Since I spoke to him last eric has become a birdwatcher, as part of his tour guide training. I'll put him in touch with judith. Perhaps there is some interest in a Rwanda bird tour.

I met this morning with people from AVEGA central and AVEGA west, and also David Russell. It seems that they are going though with the USAID grant application. If we get it that's fine, and if not it is good preparation for the next one. I gave them my capacity building grant from APF and it was along the lines that they were thinking. The only difference is the sum - millions versus thousands. Well, I won't complain about the capitalist grant system if I benefit.

A few other organizations will be involved, and I couldn't follow all the complexities of who reports to whom, and couldn't follow the financial complexities either. Clearly humanitarian organizations need accountants and managers with good will. Another educational experience.

Sunday, July 4, 2010

Sunday, July 4, 2010

I'm in kigali.

everything is going well so far. I met john baptiste at the airport and was pleased to see him. It is always good to know somebody when you arrive in a strange place, although rwanda isn't as strange as it once was.

It as a long flight almost 24 hours, and i'm tired. thank god for yoga stretching on the plane, which i did semiregulary. there was a minor mishap when i got off the plane. I had left my iphone and kindle on the plane - they fell out of my bag and i was just too tired to notice. fortunately they were retrieved in entebbe and sent back, so no harm done. where would i be without my consumer electronics.

In a new place we need our routines, or at least I do, and my iphone is part of my habitual self. I'm also in the same room i was in last time, and with the same waitstaff who were glad to see me.

things start tomorrow. I'm going to meet with david russell from surf about research, and also someone john baptiste suggested about travel to the national university.

so far so good. More to follow

Friday, July 2, 2010

Friday, July 2, 2010

I'm just about ready to leave - the taxi comes in an hour and a half - and I'm nervous. I've done all thing things on my to do list, or I think I have, and thought through my plans, so in principle I'm in good shape. However, and here is where the anxiety comes in

It's possible I forgot to put something on my to do list
It's possible that something will come up that I haven't planned on (in fact is is likely)
And so on.. I spare the reader a list of the unfolding disaster scenarios.

I've been collecting ideas about how to deal with this anxiety. They all have to do with being resilient in some way, and just going through them makes me appreciate the value of thinking about resilience. Here they are - some with attributions - some not.

Remember that everything will pass eventually - RC, who has sailed through storms around the world

It is perfectly normal to alternate between denial and panic - Chaya, who did her research interviews in a Palestinean refugee camp

Impressions and experiences are valuable, they're food. Try to eat only the good food. If the emotions get too negative, sense your body, and go with your thoughts about positive reality - John, an experienced meditator

Develop a positive self state and reappraise the emotion - me channeling a combination of George Bonnano and Phil Bromberg

Just keep going, returning to Egypt is not an option - generations of Jews

Talk about my fears to an attuned other - Sheila and self psychology.

What doesn't kill you makes you stronger - Nietzche and Lisken (a martial artist, paraphrased)

There are probably others, that i've forgotten and no doubt I'll learn more.

Anyhow, I'm getting ready to leave.
Its about an 18 hour flight, first to Brussels, then a layover, then to Kigali.
Stay tuned